Borges Claudio F, Fregonesi Adriano, Silva Daniel Carlos, Sasse André Deeke
Department of Urology, Hospital das Clínicas, State University of Campinas-UNICAMP , Campinas, São Paulo, Brazil .
J Endourol. 2010 Oct 19. doi: 10.1089/end.2010.0231.
Abstract Purpose: We performed a systemic review with meta-analysis to compare tubeless vs conventional percutaneous nephrolithotomy (PCNL) and assess the effectiveness and safety of this innovative procedure. Materials and Methods: A systematic review of PUBMED, EMBASE, LILACS, and Cochrane Library was performed to identify all randomized controlled trials (RCTs) that compared tubeless PCNL vs conventional PCNL. The analyzed outcomes were stone-free rate, pain assessment, analgesic medication requirements, operative time, hospitalization time, blood loss, and complications. Results: A total of 10 RCTs were identified that reported 621 patients. Seven studies analyzed stone-free rates. Meta-analysis of the data resulted in no difference between tubeless and conventional PCNL. Operative time, blood transfusion, hemoglobin drop and postoperative fever did not differ between the groups. Meta-analysis of length of hospitalization and prolonged urinary drainage was analyzed and favored the tubeless PCNL group. Conclusions: Tubeless PCNL is a safe and effective procedure with a stone clearance rate comparable to that of conventional PCNL. Tubeless PCNL presented a shorter hospital stay and less postoperative urinary leakage. Pain reduction and minimization of analgesic requirements also were demonstrated.
摘要 目的：我们进行了一项系统评价和荟萃分析，以比较无管与传统经皮肾镜取石术（PCNL），并评估这种创新手术的有效性和安全性。材料与方法：对PUBMED、EMBASE、LILACS和Cochrane图书馆进行系统评价，以确定所有比较无管PCNL与传统PCNL的随机对照试验（RCT）。分析的结果包括结石清除率、疼痛评估、镇痛药物需求、手术时间、住院时间、失血量和并发症。结果：共确定了10项RCT，报告了621例患者。7项研究分析了结石清除率。对数据进行荟萃分析后发现，无管PCNL与传统PCNL之间没有差异。两组之间的手术时间、输血、血红蛋白下降和术后发热没有差异。对住院时间和延长的尿液引流进行了荟萃分析，结果支持无管PCNL组。结论：无管PCNL是一种安全有效的手术，结石清除率与传统PCNL相当。无管PCNL的住院时间较短，术后尿漏较少。还证明了疼痛减轻和镇痛需求最小化。
